Villous Capillary Lesions Of Placenta
A Ten-Year Experience With Brief Review Of Literature
Keywords:
Villus Capillary Lesions, Chorangiosis, Chorangioma, Chorangiomatosis
Abstract
Background: Villous capillary (VC) lesions of placenta range from reactive to benign tumors such as chorangiosis (CH), chorangiomatosis (CM) and chorangioma (CA). Associated with perinatal morbidity and mortality, these rare lesions are documented with maternal, placental and fetal risk factors. The aim of this study was to analyze the clinico-pathological profile of VC lesions of placenta and to compare the associated risk factors between VC lesion (CH) and those with no VC lesions. Methods: This retrospective study includes all the VC lesions of Placenta diagnosed in Pondicherry Institute of medical sciences from January 2006 to February 2016. For comparison, gestational age matched controls with no VC lesions were obtained. Chi-square test or fischer’s exact test was used for statistical analysis. Results: Of 29 VC lesions of placenta (5.6%) in 10 years, 27 were CH. Commonly associated feto-maternal factors include anemia (47.4%), oligohydramnia (33.3%), infection (28.6%), pre-eclampsia (23.8%), NICU admission (47.8%), fetal growth retardation (17.4%), congenital anomaly (17.4%), intrauterine death (13%). When compared with controls, CH had significantly increased LSCS, premature rupture of membranes and histologically, chorioamnionitis and funisitis that support its infective etiology. One case of CA associated with IUGR, polyhydramnios was found to have CH in her next pregnancy which points to a possibility of genetic predisposition among VC lesions. CM was diagnosed in primi with severe pre-eclampsia and asymmetric IUGR. Conclusion: Prevalence of CH is 5.2%. VC lesions of placenta are commonly associated with complicated pregnancy and neonatal morbidity.References
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2. Altshuler G. Chorangiosis. An important placental sign of neonatal morbidity and mortality. Arch Pathol Lab Med 1984;108(1):71-4.
3. Srinivasan AP, Omprakash BO, Lavanya K, Subbulakshmi Murugesan P, Kandaswamy S. A prospective study of villous capillary lesions in complicated pregnancies. J Pregnancy 2014;2014:193925. doi:10.1155/2014/193925.
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5. Ramasamy J, Varghese RG. Pedunculated Chorangioma of Placenta - an Extremely Rare Case Report. Iran J Pathol 2013;8(4):263-6.
6. Aparna M, Archana J, Vidula G. Chorangiosis of placenta. Report of two cases. Panacea Journal of Medical Sciences 2014;4(2):50-1.
7. Agale SV, Dongaonkar DD. Chorangiosis of placenta. Bombay Hospital Journal 2009;51(2):251-2.
8. Benirschke K, Franciosi R. Placental pathology casebook. J Perinatol 1999;19:393-4.
9. Mathew M, Garg S, Rai L, Kustogi P. Placental Chorangiosis – A report of two cases with unusual associations and review of literature. The Internet Journal of Gynecology and Obstetrics 2008;11(2):1- 3.
10. Soma H, Watanabe Y, Hata T: Chorangiosis and chorangioma in three cohorts of placentas from Nepal, Tibet and Japan. Reprod Fertil Devel 1996;7:1533-8.
11. De La Ossa MM, Cabello-Inchausti B, Robinson MJ. Placental chorangiosis. Arch Pathol Lab Med 2001;125(9):1258.
12. Gupta R, Nigam S, Arora P, Khurana N, Batra S, Mandal AK. Clinico- pathological profile of 12 cases of chorangiosis. Arch Gynecol Obstet 2006;274(1):50-3.
13. Malathi BG, Manjunath MR. “Chorangiosis Placenta”. Journal of Evidence Based Medicine and Healthcare 2014;1(8):922-4.
14. Bagby C, Redline RW. Multifocal Chorangiomatosis. Pediatric and Developmental Pathology 2011;14(1):38-44.
15. Kalli K. Faulkner DO, Blythe B. Bowman MD, Elizabeth Manci MD. Diffuse Multifocal Chorangiomatosis: A Rare Entity With an Unusual Presentation. Am J clin pathol (internet) 2011(cited 2016 feb 15);136:A207. Available from: http://dx.doi.org/10.1093/ajcp/138.suppl1.191 A207
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17. Gonçalves Baptista Pereira NR, da Rocha Branco MP, Santos Silva MI, et al. Placental vascular lesion as cause of IUGR and nonimmune fetal hydrops in twin pregnancy. Rev Bras Ginecol Obstet 2011; 33(12):421-5 (article in Portuguese, abstract in English)
18. Momeni Boroujeni A, Yousefi E, Vincent MT, Anderson V. Chorangiomatosis: Evaluation of a placental vascular lesion and related clinical effects. Fetal Pediatr Pathol 2014;33(5-6):331-8.
19. Kodandapani S, Shreshta A, Ramkumar V, Rao L. Chorioangioma of placenta: a rare placental cause for adverse fetal outcome. Case Rep Obstet Gynecol 2012;2012:913878. doi: 10.1155/2012/913878.
20. Adil SAK, Shilpa K, Bharthi M, Anubha A. Giant extraplacental chorangioma: a case report and review. Journal of Evolution of Medical and Dental Sciences 2012;1(4):298-301.
21. Marchetti AA, “A consideration of certain types of benign tumors of the placenta,” Surgery, Gynecology & Obstetrics 1939;68:733–43.
22. Chen CP, Chern SR, Wang TY, Huang ZD, Huang MC, Chuang CY. Pregnancy with concomitant chorangioma and placental vascular malformation with mesenchymal hyperplasia. Human Reproduction 1997;12(11):2553-6.
23. Lez C, Fures R, Hrgovic Z, Belina S, Fajdic J, Munstedt K. Chorangioma placentae. Rare Tumors 2010; 2(4): e67. doi: 10.4081/rt.2010.e67.
24. Tihonenko I. Chorioangioma. Thefetus.net (internet) 2012 (cited 2016 feb 5); (about 8 p). Available from: http://www.sonoworld.com/fetus/page.aspx?id=3114
25. Lokuhetty D, Al Bahari M. Successful Outcome of a Pregnancy Complicated by a Voluminous Placental Chorangioma: Case report with Review of the Literature. Oman Med J (internet) 2014 May (cited 2016 feb 5); 29(4). (about 4 p). Available from: http://www.omjournal.org/fultext_PDF.aspx?DetailsID=587&type=fultext
26. Andola US, Karangadan S, Andola SK, Jewargikar R. Chorangioma of Placenta with High Risk Pregnancy: A Case Series. Journal of Basic and Clinical Reproductive Sciences 2014;3(1):71-3.
27. Abdalla N, Bachanek M, Trojanowski S, Cendrowski K, Sawicki W. Placental tumor
(chorioangioma) as a cause of polyhydramnios: a case report. International Journal of Women’s Health 2014;6:955-9.
28. Singh S, Garg S, Verma R, Chandana A, Sen R, Ralli M. Journal of Gynecologic Surgery 2015;31(1): 26-8.
29. Sahu KK, Rau A, Suresh PK. Utility of reticulin stain in the diagnosis of a completely infarcted chorangioma. Medical Journal of Dr. D.Y. Patil University 2016;9:95-7.
2. Altshuler G. Chorangiosis. An important placental sign of neonatal morbidity and mortality. Arch Pathol Lab Med 1984;108(1):71-4.
3. Srinivasan AP, Omprakash BO, Lavanya K, Subbulakshmi Murugesan P, Kandaswamy S. A prospective study of villous capillary lesions in complicated pregnancies. J Pregnancy 2014;2014:193925. doi:10.1155/2014/193925.
4. Fox H, Sebire NJ. Non-trophoblastic tumors of the placenta. In: Fox H, editors. Pathology of the placenta. Philadelphia: Saunders Elsevier; 2007:401-30.
5. Ramasamy J, Varghese RG. Pedunculated Chorangioma of Placenta - an Extremely Rare Case Report. Iran J Pathol 2013;8(4):263-6.
6. Aparna M, Archana J, Vidula G. Chorangiosis of placenta. Report of two cases. Panacea Journal of Medical Sciences 2014;4(2):50-1.
7. Agale SV, Dongaonkar DD. Chorangiosis of placenta. Bombay Hospital Journal 2009;51(2):251-2.
8. Benirschke K, Franciosi R. Placental pathology casebook. J Perinatol 1999;19:393-4.
9. Mathew M, Garg S, Rai L, Kustogi P. Placental Chorangiosis – A report of two cases with unusual associations and review of literature. The Internet Journal of Gynecology and Obstetrics 2008;11(2):1- 3.
10. Soma H, Watanabe Y, Hata T: Chorangiosis and chorangioma in three cohorts of placentas from Nepal, Tibet and Japan. Reprod Fertil Devel 1996;7:1533-8.
11. De La Ossa MM, Cabello-Inchausti B, Robinson MJ. Placental chorangiosis. Arch Pathol Lab Med 2001;125(9):1258.
12. Gupta R, Nigam S, Arora P, Khurana N, Batra S, Mandal AK. Clinico- pathological profile of 12 cases of chorangiosis. Arch Gynecol Obstet 2006;274(1):50-3.
13. Malathi BG, Manjunath MR. “Chorangiosis Placenta”. Journal of Evidence Based Medicine and Healthcare 2014;1(8):922-4.
14. Bagby C, Redline RW. Multifocal Chorangiomatosis. Pediatric and Developmental Pathology 2011;14(1):38-44.
15. Kalli K. Faulkner DO, Blythe B. Bowman MD, Elizabeth Manci MD. Diffuse Multifocal Chorangiomatosis: A Rare Entity With an Unusual Presentation. Am J clin pathol (internet) 2011(cited 2016 feb 15);136:A207. Available from: http://dx.doi.org/10.1093/ajcp/138.suppl1.191 A207
16. Chopra A, Iyer VK, Thapar R, Singh N. Diffuse multifocal chorangiomatosis of the placenta with multiple intestinal stenosis of the fetus: combination of rare causes for nonimmune hydrops fetalis. Indian J Pathol Microbiol 2006;49(4):600-2.
17. Gonçalves Baptista Pereira NR, da Rocha Branco MP, Santos Silva MI, et al. Placental vascular lesion as cause of IUGR and nonimmune fetal hydrops in twin pregnancy. Rev Bras Ginecol Obstet 2011; 33(12):421-5 (article in Portuguese, abstract in English)
18. Momeni Boroujeni A, Yousefi E, Vincent MT, Anderson V. Chorangiomatosis: Evaluation of a placental vascular lesion and related clinical effects. Fetal Pediatr Pathol 2014;33(5-6):331-8.
19. Kodandapani S, Shreshta A, Ramkumar V, Rao L. Chorioangioma of placenta: a rare placental cause for adverse fetal outcome. Case Rep Obstet Gynecol 2012;2012:913878. doi: 10.1155/2012/913878.
20. Adil SAK, Shilpa K, Bharthi M, Anubha A. Giant extraplacental chorangioma: a case report and review. Journal of Evolution of Medical and Dental Sciences 2012;1(4):298-301.
21. Marchetti AA, “A consideration of certain types of benign tumors of the placenta,” Surgery, Gynecology & Obstetrics 1939;68:733–43.
22. Chen CP, Chern SR, Wang TY, Huang ZD, Huang MC, Chuang CY. Pregnancy with concomitant chorangioma and placental vascular malformation with mesenchymal hyperplasia. Human Reproduction 1997;12(11):2553-6.
23. Lez C, Fures R, Hrgovic Z, Belina S, Fajdic J, Munstedt K. Chorangioma placentae. Rare Tumors 2010; 2(4): e67. doi: 10.4081/rt.2010.e67.
24. Tihonenko I. Chorioangioma. Thefetus.net (internet) 2012 (cited 2016 feb 5); (about 8 p). Available from: http://www.sonoworld.com/fetus/page.aspx?id=3114
25. Lokuhetty D, Al Bahari M. Successful Outcome of a Pregnancy Complicated by a Voluminous Placental Chorangioma: Case report with Review of the Literature. Oman Med J (internet) 2014 May (cited 2016 feb 5); 29(4). (about 4 p). Available from: http://www.omjournal.org/fultext_PDF.aspx?DetailsID=587&type=fultext
26. Andola US, Karangadan S, Andola SK, Jewargikar R. Chorangioma of Placenta with High Risk Pregnancy: A Case Series. Journal of Basic and Clinical Reproductive Sciences 2014;3(1):71-3.
27. Abdalla N, Bachanek M, Trojanowski S, Cendrowski K, Sawicki W. Placental tumor
(chorioangioma) as a cause of polyhydramnios: a case report. International Journal of Women’s Health 2014;6:955-9.
28. Singh S, Garg S, Verma R, Chandana A, Sen R, Ralli M. Journal of Gynecologic Surgery 2015;31(1): 26-8.
29. Sahu KK, Rau A, Suresh PK. Utility of reticulin stain in the diagnosis of a completely infarcted chorangioma. Medical Journal of Dr. D.Y. Patil University 2016;9:95-7.
Published
2018-09-27
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